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Panarelli NC. Infectious Mimics of Inflammatory Bowel Disease. Mod Pathol 2023:100210. [PMID: 37172904 DOI: 10.1016/j.modpat.2023.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Distinguishing inflammatory bowel disease (IBD) from its mimics remains a diagnostic challenge for surgical pathologists. Several gastrointestinal infections produce inflammatory patterns that overlap with typical findings of IBD. Although stool culture, PCR, and other clinical assays may identify infectious enterocolitides, these tests may not be performed or the results may be unavailable at the time of histologic evaluation. Furthermore, some clinical tests, including stool PCR, may reflect past exposure rather than ongoing infection. It is important for surgical pathologists to be knowledgeable about infections that simulate IBD in order to generate an accurate differential diagnosis, perform appropriate ancillary studies, and prompt clinical follow-up. This review covers bacterial, fungal, and protozoal infections in the differential diagnosis of IBD.
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Affiliation(s)
- Nicole C Panarelli
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
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2
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Hirsch RD, Tambakis G, Shelton E. Getting to the bottom of persistent proctitis. Intern Med J 2022; 52:895-896. [PMID: 35538017 DOI: 10.1111/imj.15785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/05/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ryan D Hirsch
- Gastroenterology Unit, Monash Health, Melbourne, Victoria, Australia
| | - George Tambakis
- Gastroenterology Unit, Monash Health, Melbourne, Victoria, Australia
| | - Edward Shelton
- Gastroenterology Unit, Monash Health, Melbourne, Victoria, Australia
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3
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Ghanta SN, Saccente M. Chronic Lymphogranuloma Venereum Proctocolitis Masquerading as Inflammatory Bowel Disease. J Investig Med High Impact Case Rep 2022; 10:23247096221107233. [PMID: 35762449 PMCID: PMC9244905 DOI: 10.1177/23247096221107233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022] Open
Abstract
Rectal infection with the L1, L2, and L3 serovars of Chlamydia trachomatis can cause lymphogranuloma venereum (LGV) proctocolitis, particularly among men who have sex with men (MSM). Symptoms of this sexually transmitted infection include anal pain, rectal bleeding and discharge, tenesmus, constipation, and fever. Clinicians should consider LGV when there is a history of receptive anal intercourse and symptoms of proctocolitis. A positive nucleic acid amplification test (NAAT) on a rectal sample is diagnostic. This report describes a man with HIV and chronic proctocolitis in whom the diagnosis of LGV was delayed because the clinical picture mimicked inflammatory bowel disease.
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Affiliation(s)
| | - Michael Saccente
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 719] [Impact Index Per Article: 239.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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5
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Whole-Genome Enrichment and Sequencing of Chlamydia trachomatis Directly from Patient Clinical Vaginal and Rectal Swabs. mSphere 2021; 6:6/2/e01302-20. [PMID: 33658279 PMCID: PMC8546720 DOI: 10.1128/msphere.01302-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chlamydia trachomatis, an obligately intracellular bacterium, is the most prevalent cause of bacterial sexually transmitted infections (STIs) worldwide. Numbers of U.S. infections of the urogenital tract and rectum have increased annually. Because C. trachomatis is not easily cultured, comparative genomic studies are limited, restricting our understanding of strain diversity and emergence among populations globally. While Agilent SureSelectXT target enrichment RNA bait libraries have been developed for whole-genome enrichment and sequencing of C. trachomatis directly from clinical urine, vaginal, conjunctival, and rectal samples, public access to these libraries is not available. We therefore designed an RNA bait library (34,795 120-mer probes based on 85 genomes, versus 33,619 probes using 74 genomes in a previous one) to augment organism sequencing from clinical samples that can be shared with the scientific community, enabling comparison studies. We describe the library and limit of detection for genome copy input, and we present results of 100% efficiency and high-resolution determination of recombination and identical genomes within vaginal-rectal specimen pairs in women. This workflow provides a robust approach for discerning genomic diversity and advancing our understanding of the molecular epidemiology of contemporary C. trachomatis STIs across sample types, geographic populations, sexual networks, and outbreaks associated with proctitis/proctocolitis among women and men who have sex with men.IMPORTANCE Chlamydia trachomatis is an obligate intracellular bacterium that is not easily cultured, which limits our understanding of urogenital and rectal C. trachomatis transmission and impact on morbidity. To provide a publicly available workflow for whole-genome target enrichment and sequencing of C. trachomatis directly from clinical urine, vaginal, conjunctival, and rectal specimens, we developed and report on an RNA bait library to enrich the organism from clinical samples for sequencing. We demonstrate an increased efficiency in the percentage of reads mapping to C. trachomatis and identified recombinant and identical C. trachomatis genomes in paired vaginal-rectal samples from women. Our workflow provides a robust genomic epidemiologic approach to advance our understanding of C. trachomatis strains causing ocular, urogenital, and rectal infections and to explore geo-sexual networks, outbreaks of colorectal infections among women and men who have sex with men, and the role of these strains in morbidity.
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van Aar F, Kroone MM, de Vries HJ, Götz HM, van Benthem BH. Increasing trends of lymphogranuloma venereum among HIV-negative and asymptomatic men who have sex with men, the Netherlands, 2011 to 2017. ACTA ACUST UNITED AC 2020; 25. [PMID: 32290900 PMCID: PMC7160438 DOI: 10.2807/1560-7917.es.2020.25.14.1900377] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction Lymphogranuloma venereum (LGV), an invasive form of Chlamydia trachomatis infection, has been reported among (mainly HIV-positive) men who have sex with men (MSM) since 2003. In the Netherlands, LGV testing recommendations changed from selective to universal testing in 2015. Changes in tested populations could have led to incomparable LGV positivity rates over time. Aim We investigated LGV trends among MSM attending Centres for Sexual Health using surveillance data between 2011 and 2017. Methods LGV positivity was calculated among MSM tested for rectal Chlamydia infection and MSM tested specifically for LGV. With multivariable logistic regression analysis, the association between years and LGV was adjusted for testing indicators and determinants. Results We included 224,194 consultations. LGV increased from 86 in 2011 to 270 in 2017. Among LGV-positives, proportions of HIV-negative and asymptomatic MSM increased from 17.4% to 45.6% and from 31.4% to 49.3%, respectively, between 2011 and 2017. Among MSM tested for rectal chlamydia, LGV positivity increased from 0.12% to 0.33% among HIV-negatives and remained stable around 2.5% among HIV-positives. Among LGV-tested MSM, LGV positivity increased from 2.1% to 5.7% among HIV-negatives and from 15.1% to 22.1% among HIV-positives. Multivariable models showed increased odds ratios and significant positive associations between years and LGV. Conclusions Although increased testing and changes in LGV incidence are difficult to disentangle, we found increasing LGV trends, especially when corrected for confounding. LGV was increasingly attributed to HIV-negative and asymptomatic MSM, among whom testing was previously limited. This stresses the importance of universal testing and continuous surveillance.
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Affiliation(s)
- Fleur van Aar
- Centre of Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Michelle M Kroone
- Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, Amsterdam
| | - Henry Jc de Vries
- Department of Dermatology, Amsterdam Institute for Infections and Immunity (AI&II), Amsterdam University Medical Centres, Location Academic Medical Centre, Amsterdam, the Netherlands.,Department of Infectious Diseases, Public Health Service (GGD) Amsterdam, Amsterdam
| | - Hannelore M Götz
- Department of Infectious Disease Control, Municipal Public Health Service, Rotterdam, the Netherlands.,Centre of Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Birgit Hb van Benthem
- Centre of Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
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Young TK, Gutierrez D, Zampella JG. An Overview of Penile and Scrotal Dermatoses. Urology 2020; 142:14-21. [DOI: 10.1016/j.urology.2020.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/22/2020] [Accepted: 04/05/2020] [Indexed: 11/16/2022]
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Rizza S, Mistrangelo M, Ribaldone DG, Morino M, Astegiano M, Saracco GM, Pellicano R. Proctitis: a glance beyond inflammatory bowel diseases. MINERVA GASTROENTERO 2020; 66:252-266. [PMID: 32218425 DOI: 10.23736/s1121-421x.20.02670-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Proctitis is an inflammation involving the anus and the distal part of the rectum, frequently diagnosed in the context of inflammatory bowel diseases (IBD). Nevertheless, when the standard therapy for IBD is ineffective, it becomes necessary for the clinician to review alternative etiologies, beginning from the broad chapter of infectious causes up to rare causes such as radiation, ischemia, diversion and traumatisms. While it is possible to find infectious proctitides caused by pathogens generally inducing extensive colitis, the growing incidence of both sexually transmitted infections and isolated proctitis reported in the recent years require a lot of attention. The risk appears to be higher in individuals participating in anal intercourse, especially men having sex with men (MSM) or subjects who use sex toys and participate to sex parties, dark rooms and so on. The commonest implicated pathogens are Neysseria gonorrhoeae, Chlamydia trachomatis, Herpes Simplex virus and Treponema pallidum. Herpes and Chlamydia infections mainly occur in HIV-positive MSM patients. Since symptoms and signs are common independently from etiology, performing a differential diagnosis based on clinical manifestations is complicated. Therefore, the diagnosis is supported by the combination of clinical history and physical examination and, secondly, by endoscopic, serologic and microbiologic findings. Particular emphasis should be given to simultaneous infections by multiple organisms. The involvement of experts in infectious diseases and in sexual health is crucial for the diagnostic and therapeutic management. The available therapies, empirically initiated or specific, in many cases are able to guarantee a good prognosis and to prevent relapses.
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Affiliation(s)
- Stefano Rizza
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Davide G Ribaldone
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Astegiano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giorgio M Saracco
- Unit of Gastroenterology, Department of Medical Sciences, University of Turin, Turin, Italy.,Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
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De Seta F, Comar M, De Santo D, Larsen B, Zito G. Novel Approach to Chlamydia trachomatis Infections in Female and Male. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Di Altobrando A, Tartari F, Filippini A, D'Antuono A, Patrizi A, Filippi F, Sechi A, Cuicchi D, Salfi NCM, Gaspari V. Lymphogranuloma venereum proctitis mimicking inflammatory bowel diseases in 11 patients: a 4-year single-center experience. CROHN'S & COLITIS 360 2019. [DOI: 10.1093/crocol/otz004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
ABSTRACT
Lymphogranuloma venereum (LGV) is a sexually transmitted disease caused by Chlamydia trachomatis (CT) serovars L1–L3. Our study wants to underline the similarities between rectal LGV and idiopathic inflammatory bowel diseases (IBD), which can share clinical, endoscopic and histopathological findings.
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Affiliation(s)
- Ambra Di Altobrando
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federico Tartari
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Andrea Filippini
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Universita degli Studi di Bologna Scuola di Medicina e Chirurgia, Bologna, Italy
| | - Antonietta D'Antuono
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federica Filippi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Andrea Sechi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Dajana Cuicchi
- Surgery of the Alimentary Tract, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Valeria Gaspari
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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11
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De Baetselier I, Tsoumanis A, Verbrugge R, De Deken B, Smet H, Abdellati S, Cuylaerts V, Apers L, Crucitti T. Lymphogranuloma venereum is on the rise in Belgium among HIV negative men who have sex with men: surveillance data from 2011 until the end of June 2017. BMC Infect Dis 2018; 18:689. [PMID: 30572839 PMCID: PMC6302394 DOI: 10.1186/s12879-018-3600-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 12/07/2018] [Indexed: 01/06/2023] Open
Abstract
Background The number of cases of Lymphogranuloma venereum (LGV) is increasing in Europe. The described epidemic is mostly confined to HIV positive men who have sex with men (MSM). However, dissemination of LGV from HIV positive to HIV negative MSM could take place due to the implementation of pre-exposure prophylaxis (PrEP) and subsequent possible decrease in condom use. We describe here the LGV epidemiology in Belgium before the PrEP-era, starting from 2011 up to the end of the first half of 2017. Methods A descriptive analysis of the socio-demographic and clinical characteristics of all LGV cases was performed. Fisher’s exact test was used to compare symptomatic to asymptomatic patients. Logistic regression models were used to check for trends over time for: number of LGV cases, HIV status and symptoms. Results The number of LGV cases rose by a factor four, from 21 in 2011 to 88 in 2016, and regression models showed a positive trend estimate of 14% increase per half year (p < 0.001). LGV decreased among HIV positive cases (odds ratio (OR): 0.79, p < 0.001) and increased among HIV negative cases (OR: 1.27, p < 0.001). In addition, a rise in the number of asymptomatic LGV cases (6.7%) was observed (OR:1.39, p = 0.047). Asymptomatic cases were also less likely to be HIV (p = 0.046) or Hepatitis C positive (p = 0.027). Conclusions The rise of LGV in HIV negative MSM has now been documented. If we aim to halt the epidemic in HIV negative MSM, future public health strategies should include LGV testing of all Chlamydia trachomatis positive samples from MSM.
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Affiliation(s)
- Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Ruth Verbrugge
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Bénédicte De Deken
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Hilde Smet
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Saïd Abdellati
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Vicky Cuylaerts
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Ludwig Apers
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Tania Crucitti
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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Diaz A, Ruiz-Algueró M, Hernando V. Lymphogranuloma venereum in Spain, 2005-2015: A literature review. Med Clin (Barc) 2018; 151:412-417. [PMID: 30166126 DOI: 10.1016/j.medcli.2018.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/24/2018] [Accepted: 05/26/2018] [Indexed: 12/14/2022]
Abstract
Lymphogranuloma venereum (LGV) was an unusual disease in Europe until 2003, when several outbreaks among men who have sex with men (MSM) emerged. Since 2015, LGV has been included notifiable disease in Spain. Our aim is to review LGV cases published in Spain from 2005 to 2015. Fourteen studies met the inclusion criteria describing cases in 7autonomous regions. Most cases were MSM, Spaniards, aged between 30-45, with anorectal syndrome. L2 was the predominant serotype isolated. More than 60% of the cases among MSM were co-infected with HIV and nearly half of those reported another concurrent STI. Since the first LGV case published more than 10years ago, this disease has spread across Spain. Epidemiological and clinical characteristics of cases are similar to cases described in Europe. Implementation of national surveillance will improve information about LGV's magnitude and its evolution, key elements for its control.
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Affiliation(s)
- Asunción Diaz
- Unidad de Vigilancia del VIH/Sida y Comportamientos de Riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España.
| | - Marta Ruiz-Algueró
- Unidad de Vigilancia del VIH/Sida y Comportamientos de Riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | - Victoria Hernando
- Unidad de Vigilancia del VIH/Sida y Comportamientos de Riesgo, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
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13
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Cabello A, Górgolas M. Anorectal sexually transmitted infections. An infradiagnosticated epidemic. Med Clin (Barc) 2018; 152:102-103. [PMID: 30146356 DOI: 10.1016/j.medcli.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Alfonso Cabello
- División de Enfermedades Infecciosas, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España.
| | - Miguel Górgolas
- División de Enfermedades Infecciosas, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
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Levy I, Gefen-Halevi S, Nissan I, Keller N, Pilo S, Wieder-Finesod A, Litchevski V, Shasha D, Kedem E, Rahav G. Delayed diagnosis of colorectal sexually transmitted diseases due to their resemblance to inflammatory bowel diseases. Int J Infect Dis 2018; 75:34-38. [PMID: 30125691 DOI: 10.1016/j.ijid.2018.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/09/2018] [Accepted: 08/11/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Sexually transmitted diseases (STDs), mainly lymphogranuloma venereum (LGV), induce colorectal symptoms that may be misdiagnosed as inflammatory bowel disease (IBD). This study describes patients who presented with STDs masquerading as IBD in order to improve understanding of missed diagnosis of colorectal STDs and their association with LGV in Israel. METHODS This retrospective, descriptive study characterized the clinical, endoscopic, and pathological findings of 16 patients who were diagnosed with a colorectal STD after erroneously being diagnosed with IBD. Molecular genotyping was used to characterize some of the Chlamydia trachomatis isolates. RESULTS All patients were men who have sex with men (MSM), mostly HIV-1-positive, and had clinical and endoscopic findings compatible with IBD. The STD was diagnosed 1-36 months after the initial diagnosis: 14 were positive for Chlamydia trachomatis, of which three were of the LGV2b (ST58) serotype and one was ST 108 serotype. Five were positive for gonorrhea and four were positive for syphilis. Several pathogens were diagnosed in six episodes. CONCLUSIONS Colorectal STDs may resemble IBD and therefore their diagnosis may be delayed. IBD symptoms in MSM who engage in non-protected anal sex should prompt at least syphilis and anal PCR for STD testing. If C. trachomatis is diagnosed but LGV subtyping cannot be done, doxycycline 100mg twice daily for 21days should be recommended.
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Affiliation(s)
- Itzchak Levy
- Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
| | | | - Israel Nissan
- Ministry of Health, National Public Health Laboratory, Chlamydia National Reference Laboratory, Tel Aviv, Israel
| | - Natan Keller
- Microbiology Laboratory, Sheba Medical Center, Ramat Gan, Israel; Ariel University, Ariel, Israel
| | - Shlomo Pilo
- Ministry of Health, National Public Health Laboratory, Chlamydia National Reference Laboratory, Tel Aviv, Israel
| | | | - Vlady Litchevski
- Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel
| | - David Shasha
- Infectious Disease Unit, Tel Aviv - Sourasky Medical Center, Tel Aviv, Israel
| | - Eynat Kedem
- Immunology Department and AIDS Center, Rambam Medical Center, Haifa, Israel
| | - Galia Rahav
- Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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15
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Foschi C, Gaspari V, Sgubbi P, Salvo M, D'Antuono A, Marangoni A. Sexually transmitted rectal infections in a cohort of 'men having sex with men'. J Med Microbiol 2018; 67:1050-1057. [PMID: 29927376 DOI: 10.1099/jmm.0.000781] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE We assessed the prevalence and predictors of Chlamydia trachomatis, Neisseriagonorrhoeae and Mycoplasmagenitalium rectal infections in a population of 'men having sex with men' (MSM). METHODOLOGY From January to November 2017, 165 MSM attending a STI outpatients clinic in Bologna (Italy) and reporting unsafe anal intercourses were enrolled. An ano-rectal swab was collected from each patient: chlamydial and gonococcal infections were diagnosed by a commercial NAAT, whereas an in-house quantitative PCR was used for M. genitalium detection. In addition, 131 urine samples and 84 pharyngeal swabs underwent testing for C. trachomatis and N. gonorrhoeae. A molecular C. trachomatis typing, a serological screening for anti-Chlamydia IgG and IgA, as well as the assessment of HIV, HCV and syphilis infections, were performed.Results/Key findings. The prevalence of C. trachomatis, N. gonorrhoeae and M. genitalium rectal infections was 27.2, 25.4 and 4.8 %, respectively. Globally, 63.1 % of cases were asymptomatic and up to 80 % of chlamydial and gonococcal infections would have been missed if the rectal site had not been tested. All the patients with rectal M. genitalium carriage were asymptomatic and characterized by low bacterial loads (<2500 DNA copies/reaction). Lymphogranuloma venereum (LGV) prevalence was 12.1 % with a considerable proportion of asymptomatic infections (35 %). The presence of symptoms, age >30, HIV-positivity and elevated levels of anti-Chlamydia antibodies were the most significant predictors of LGV. CONCLUSIONS Sexually transmitted rectal infections are frequent and often asymptomatic among MSM. LGV prevalence is high in our country and there is increasing evidence of symptomless cases.
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Affiliation(s)
- Claudio Foschi
- 1Microbiology, DIMES, University of Bologna, Bologna, Italy
| | | | - Paola Sgubbi
- 2Dermatology, DIMES, University of Bologna, Bologna, Italy
| | - Melissa Salvo
- 1Microbiology, DIMES, University of Bologna, Bologna, Italy
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Clinical diagnostic and therapeutic aspects of 221 consecutive anorectal Chlamydia trachomatis and Neisseria gonorrhoeae sexually transmitted infections among men who have sex with men. Int J Infect Dis 2018; 71:9-13. [PMID: 29608959 DOI: 10.1016/j.ijid.2018.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/22/2018] [Accepted: 03/25/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Proctitis caused by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are known as sexually transmitted infections (STI). This study describes their clinical, diagnostic and therapeutic aspects. METHODS Between 01/2013-03/2015, all MSM consulting for proctitis at proctology Institute-Saint-Joseph's Hospital, Paris, were included. Demographic, past-medical history, STI status and medical treatment were collected. Detection of CT/NG was performed by Transcription-Mediated Amplification (TMA) and antimicrobial susceptibilities for Ng by agar diffusion method. RESULTS On 441 rectal samples collected, 221 (50.1%) were positive: 109 Ct (49.3%), 70 Ng (31.7%), 42 positive for both etiologies (19%). Among Ng infections, no resistance was detected to azithromycin and ceftriaxone. However, 84 strains (43.2%) were resistant to fluoroquinolones. More than one episode was diagnosed for 10 (5.1%) and 12 (6.2%) patients with CT and NG infections respectively. Anal abscesses were found for 27 (13.9%) patients, and 14 (7.2%) of them underwent surgery for anal fistula. CONCLUSIONS The prevalence of CT/NG anorectal infections described is high on symptomatic patients, and a significant level of abscess was reported. These results confirm the interest of the association of recommended antibiotics excluding quinolones. Prospective studies would be relevant on complicated forms of anorectal infections.
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Charest L, Fafard J, Greenwald ZR. Asymptomatic urethral lymphogranuloma venereum: a case report. Int J STD AIDS 2018; 29:828-830. [PMID: 29350113 DOI: 10.1177/0956462417751813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since 2003, there has been a resurgence of lymphogranuloma venereum (LGV), a variant of Chlamydia trachomatis (CT), among men who have sex with men (MSM) in several urban areas of Europe and North America. LGV infection occurs most often at anal sites causing proctitis. Urethral and oropharyngeal infections are rare. In Quebec, LGV incidence has been increasing exponentially in recent years and the current guidelines support systematic LGV genotype testing among anorectal CT-positive samples only. This case report describes a patient with a urethral LGV infection, remarkable due to its prolonged asymptomatic development prior to the manifestation of an inguinal bubo. Physicians should be vigilant of potential cases of LGV and forward CT-positive samples occurring among individuals with LGV risk factors for genotype testing.
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Affiliation(s)
| | - Judith Fafard
- 1 Clinique médicale l'Actuel, Montréal, Canada.,2 Centre intégré de santé et de services sociaux (CISSS) de Lanaudière, Joliette, Canada
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Anorectal Lymphogranuloma Venereum in Madrid: A Persistent Emerging Problem in Men Who Have Sex With Men. Sex Transm Dis 2017; 43:414-9. [PMID: 27322040 DOI: 10.1097/olq.0000000000000459] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since 2003, outbreaks of lymphogranuloma venereum (LGV) with anorectal syndrome have been increasingly recognized in many Western countries. All of them have been classified as LGV serovar L2b, mainly occurring in human immunodeficiency virus (HIV)-infected men who have had sex with men (MSM). We describe a series of 26 diagnosed cases of LGV proctitis in downtown Madrid, Spain, in 2014, after implementing routine diagnostic procedures for this disease in symptomatic MSM. METHODS We conducted an observational study of patients with symptomatic proctitis attending an outpatient infectious diseases clinic in Madrid, Spain during calendar year 2014. Clinical, epidemiological, laboratory, and therapeutic data were gathered and analyzed. RESULTS Twenty-six patients were included in the analysis. All were MSM, and 24 of them were HIV-positive. All patients reported having acute proctitis symptoms including tenesmus (85%), pain (88%), constipation (62%), or anal discharge (96%). Proctoscopy showed mucopurulent exudate (25 patients [96%]), and rectal bleeding, with mucosal erythema and/or oedema in all cases. Rectal swabs were obtained from all patients, and LGV serovar L2 was confirmed in all of them. The cure rate was 100% after standard treatments with doxycycline 100 mg twice per day for 3 weeks. Simultaneous rectal infections with other sexually transmitted pathogens (gonorrhoea, herpes simplex virus, Mycoplasma genitalium) and systemic sexually transmitted diseases (STDs) (syphilis, acute HIV, and hepatitis C infections) were also documented in 12 patients (46%), but these co-infections did not appear to influence the clinical manifestations of LGV. CONCLUSIONS Anorectal LGV is a common cause of acute proctitis and proctocolitis among HIV-infected MSM who practice unprotected anal sex, and it is frequently associated with other rectal STDs. The implementation of routine screening and prompt diagnosis of these rectal infections should be mandatory in all clinical settings attended by HIV and STD patients.
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Fabre-Baudouin A, Roux AL, Marin C, Lachatre M, De Laroche M, Ponsoye M, Hanslik T, Trad S. [Diagnostic issues of lymphogranuloma venereum: A case series of 5 patients]. Rev Med Interne 2017; 38:794-799. [PMID: 29128125 DOI: 10.1016/j.revmed.2017.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/26/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Lymphogranuloma venereum (LG) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis L serovar. METHODS These five consecutive cases aim to highlight the risk of LG misdiagnosis, in case of initial presentation with isolated inguinal adenitis. RESULTS Five men (mean age: 30±7 years) were seen in an internal medicine department, for inguinal adenopathy. One patient had clinical signs of urethritis. None presented an associated rectitis. Three patients had a history of STI, and two had a discovery of related HIV disease. Urinary polymerase chain reaction (PCR) was positive for the symptomatic patient and negative for the others. Lymph node PCR was positive in all patients within a L2b serotype (searched in 4 out of 5 cases). CONCLUSION LG should be evoked in any patient with inguinal adenomegaly, particularly in case of STI history or risk factors. Negativity of urinary PCR should lead to further investigations, essentially a lymph node cytopuncture to evidence C. trachomatis.
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Affiliation(s)
- A Fabre-Baudouin
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - A L Roux
- Laboratoire de microbiologie, hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France; UMR1173, Inserm, UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - C Marin
- Laboratoire d'anatomopathologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - M Lachatre
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - M De Laroche
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Laboratoire d'anatomopathologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - M Ponsoye
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Laboratoire d'anatomopathologie, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | - T Hanslik
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; Université Versailles-Saint-Quentin-en-Yvelines (UVSQ), 78180 Montigny-le-Bretonneux, France
| | - S Trad
- Service de médecine interne, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France.
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Jenni F, Rampini S. [Not Available]. PRAXIS 2017; 106:911-918. [PMID: 28830325 DOI: 10.1024/1661-8157/a002766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Zusammenfassung: Inguinal vergrösserte Lymphknoten stellen nach zervikalen Lymphadenopathien die zweithäufigste Lokalisation regionaler Lymphadenopathien dar. Die Differenzialdiagnose ist breit und geht von harmlosen lokalen Läsionen im Drainagegebiet über Infektionen wie insbesondere sexuell übertragbare Erkrankungen bis hin zu malignen Erkrankungen. Wegweisend im Abklärungsalgorithmus sind insbesondere eine fundierte Anamnese, die Klinik sowie im Weiteren spezifische Laboruntersuchungen und bei begründetem Verdacht oder verbleibender Unklarheit die Feinnadelpunktion bzw. Lymphknotenexzisionsbiopsie. Das folgende CME gibt eine Übersicht über die Differenzialdiagnose und weist eine mögliche Abklärungsstrategie auf.
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Affiliation(s)
- Fabienne Jenni
- 1 Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
| | - Silvana Rampini
- 1 Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
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21
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Turingan RS, Kaplun L, Krautz-Peterson G, Norsworthy S, Zolotova A, Joseph SJ, Read TD, Dean D, Tan E, Selden RF. Rapid detection and strain typing of Chlamydia trachomatis using a highly multiplexed microfluidic PCR assay. PLoS One 2017; 12:e0178653. [PMID: 28562672 PMCID: PMC5451082 DOI: 10.1371/journal.pone.0178653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/16/2017] [Indexed: 11/19/2022] Open
Abstract
Nucleic acid amplification tests (NAATs) are recommended by the CDC for detection of Chlamydia trachomatis (Ct) urogenital infections. Current commercial NAATs require technical expertise and sophisticated laboratory infrastructure, are time-consuming and expensive, and do not differentiate the lymphogranuloma venereum (LGV) strains that require a longer duration of treatment than non-LGV strains. The multiplexed microfluidic PCR-based assay presented in this work simultaneously interrogates 13 loci to detect Ct and identify LGV and non-LGV strain-types. Based on amplified fragment length polymorphisms, the assay differentiates LGV, ocular, urogenital, and proctocolitis clades, and also serovars L1, L2, and L3 within the LGV group. The assay was evaluated in a blinded fashion using 95 clinical swabs, with 76 previously reported as urogenital Ct-positive samples and typed by ompA genotyping and/or Multi-Locus Sequence Typing. Results of the 13-plex assay showed that 51 samples fell within urogenital clade 2 or 4, 24 samples showed both clade 2 and 4 signatures, indicating possible mixed infection, gene rearrangement, or inter-clade recombination, and one sample was a noninvasive trachoma biovar (either a clade 3 or 4). The remaining 19 blinded samples were correctly identified as LGV clade 1 (3), ocular clade 3 (4), or as negatives (12). To date, no NAAT assay can provide a point-of-care applicable turnaround time for Ct detection while identifying clinically significant Ct strain types to inform appropriate treatment. Coupled with rapid DNA processing of clinical swabs (approximately 60 minutes from swab-in to result-out), the assay has significant potential as a rapid POC diagnostic for Ct infections.
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Affiliation(s)
| | - Ludmila Kaplun
- NetBio, Waltham, Massachusetts, United States of America
| | | | | | - Anna Zolotova
- NetBio, Waltham, Massachusetts, United States of America
| | - Sandeep J. Joseph
- Department of Medicine, Division of Infectious Diseases and Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Timothy D. Read
- Department of Medicine, Division of Infectious Diseases and Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Deborah Dean
- Center for Immunobiology and Vaccine Development, Children’s Hospital Oakland Research Institute, Oakland, California, United States of America
- University of California at San Francisco School of Medicine, San Francisco, California, United States of America
- University of California at Berkeley and University of California at San Francisco Joint Graduate Program in Bioengineering, Berkeley, California, United States of America
| | - Eugene Tan
- NetBio, Waltham, Massachusetts, United States of America
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Parra-Sánchez M, García-Rey S, Pueyo Rodríguez I, Viciana Fernández P, Torres Sánchez MJ, Palomares Folía JC. Clinical and epidemiological characterisation of lymphogranuloma venereum in southwest Spain, 2013-2015. Sex Transm Infect 2016; 92:629-631. [PMID: 27288416 DOI: 10.1136/sextrans-2015-052453] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 04/29/2016] [Accepted: 05/23/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Lymphogranuloma venereum (LGV) infections caused by Chlamydia trachomatis L serovars have emerged in 2003 in Europe among HIV-positive men having sex with men (MSM). Our aim was to evaluate LGV prevalence and predictors in a high-risk population attending to two STI clinics in the southwest of Spain between December 2013 and April 2015. METHODS Screening of C. trachomatis using commercial kits was carried out, followed by real-time pmpH-PCR discriminating LGV strains, and finally ompA gene was sequenced for phylogenetic reconstruction. RESULTS A total of 6398 samples were tested, of which, 594 (9.3%) were C. trachomatis-positive specimens and successfully typed by pmpH PCR. Five hundred and eighty-one samples contained non-LGV and 13 (2.2%; 95% CI 1.3% to 3.7%) samples had LGV. One hundred and sixty-six (27.9%; 95% CI 24.5% to 31.7%) CT-positive results were found in MSM. All C. trachomatis LGV types were found in rectal samples from MSM (13/166, 7.8%; 95% CI 4.5% to 13.0%). Of these, five (38.5%; 95% CI 17.7% to 64.5%) patients were asymptomatic and 11 (84.6%; 95% CI 57.8% to 95.7%; p<0.001) were also HIV positive. Successful treatment of LGV was achieved in all patients including 11/13 (84.6%) who received single-dose azithromycin. All of the L types were confirmed to be genotype L2b with ompA PCR and sequencing. CONCLUSIONS This analysis shows that LGV infections are occurring in MSM in southwest Spain, where no data about LGV have been described before, reinforcing the need for screening and genotyping for LGV. LGV should be taken into account when considering treatment and management of rectal C. trachomatis infections, including in asymptomatic HIV-positive MSM. Larger studies on appropriate treatment for asymptomatic LGV infection are needed.
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Affiliation(s)
- Manuel Parra-Sánchez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología (UCEIM), Hospital Universitario de Valme, Seville, Spain
| | - Silvia García-Rey
- Unidad Clínica de Enfermedades Infecciosas y Microbiología (UCEIM), Hospital Universitario de Valme, Seville, Spain
| | | | - Pompeyo Viciana Fernández
- Servicio Enfermedades Infecciosas y Microbiología Clínica (UCEIM), Hospital Virgen del Rocío, Seville, Spain
| | | | - José Carlos Palomares Folía
- Unidad Clínica de Enfermedades Infecciosas y Microbiología (UCEIM), Hospital Universitario de Valme, Seville, Spain
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Decker CF. Emerging sexually transmitted diseases: Hepatitis C, lymphogranuloma venereum (LGV), and Mycoplasma genitalium infections. Dis Mon 2016; 62:314-8. [PMID: 27109045 DOI: 10.1016/j.disamonth.2016.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Foschi C, Nardini P, Banzola N, D'Antuono A, Compri M, Cevenini R, Marangoni A. Chlamydia trachomatis infection prevalence and serovar distribution in a high-density urban area in the north of Italy. J Med Microbiol 2016; 65:510-520. [PMID: 27046236 DOI: 10.1099/jmm.0.000261] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to assess Chlamydia trachomatis (CT) infection prevalence and serovar distribution in a high-density urban area in the north of Italy, by comparing different groups of subjects divided on the basis of the type of care provider they referred to (STI Clinic, gynaecologists or general practitioners). From January 2011 to May 2014, all the specimens submitted to the Microbiology Laboratory of St Orsola Hospital in Bologna for CT detection were tested by PCR assay. For positive specimens, molecular genotyping based on RFLP analysis was performed. Total prevalence of CT infection was 8.1 %, with significant differences between subgroups (P<0.01) but stable during the study period. The STI Clinic was mainly responsible for CT diagnosis, whereas the lowest infection prevalence was detected in gynaecological clinics, despite the high number of tests performed. Extra-genital samples were almost exclusively collected from males at the STI Clinic. Interestingly, 13.3 % of patients providing extra-genital specimens were positive for CT on rectal and/or pharyngeal swabs, and 4.4 % of cases would have been missed if extra-genital sites had not been tested. The most common serovar was E, and serovar distribution was influenced by gender (P<0.01), age (P<0.01), care provider (P=0.01) and anatomical site (P<0.01). The L2 serovar was detected only in extra-genital samples from males at the STI Clinic. Knowledge about care providers' contributions in CT testing and diagnosis is essential for infection control. CT typing is crucial for appropriate management of specific infections, such as lymphogranuloma venereum in extra-genital samples of high-risk populations.
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Affiliation(s)
- Claudio Foschi
- Microbiology, DIMES, University of Bologna, Bologna, Italy
| | - Paola Nardini
- Microbiology, DIMES, University of Bologna, Bologna, Italy
| | | | | | - Monica Compri
- Microbiology, DIMES, University of Bologna, Bologna, Italy
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Lee KJ, Kim J, Shin DH, Jung JO, Koh S, Kim KY, Lee JM. Chlamydial Proctitis in a Young Man Who Has Sex with Men: Misdiagnosed as Inflammatory Bowel Disease. Chonnam Med J 2015; 51:139-41. [PMID: 26730366 PMCID: PMC4697115 DOI: 10.4068/cmj.2015.51.3.139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 11/15/2022] Open
Abstract
We report the case of a 20-year-old man with a 2-month history of anal pain and bloody rectal discharge. He was referred to our clinic of gastroenterology for suspected inflammatory bowel disease (IBD). The colonoscopy showed mucosal nodularities on the rectum and an anal tag. Because the colonoscopic findings were not consistent with the typical manifestations of IBD, we took an additional sexual history and performed studies for infectious proctitis, including serologic tests for Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum. He had homosexual experience, and the serologic tests and PCR of a rectal swab were positive for C. trachomatis infection. Finally he was diagnosed as having chlamydial proctitis and was treated with intramuscular ceftriaxone 250 mg in a single dose and doxycycline 100 mg orally twice daily for 7 days. After 2 months, he had no lower abdominal symptoms and his endoscopic findings were improved.
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Affiliation(s)
- Kyung Jin Lee
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jaeyeon Kim
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Dong Hwan Shin
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jun Oh Jung
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Seokyoung Koh
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Ka Young Kim
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Jae Min Lee
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
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Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. Background review for the '2015 European guideline on the management of Chlamydia trachomatis infections'. Int J STD AIDS 2015:0956462415618838. [PMID: 26608578 DOI: 10.1177/0956462415618838] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
SummaryChlamydia trachomatis infections are major public health concerns globally. Of particular grave concern is that the majority of persons with anogenital Chlamydia trachomatis infections are asymptomatic and accordingly not aware of their infection, and this silent infection can subsequently result in severe reproductive tract complications and sequelae. The current review paper provides all background, evidence base and discussions for the 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS 2015). Comprehensive information and recommendations are included regarding the diagnosis, treatment and prevention of anogenital, pharyngeal and conjunctival Chlamydia trachomatis infections in European countries. However, Chlamydia trachomatis also causes the eye infection trachoma, which is not a sexually transmitted infection. The 2015 European Chlamydia trachomatis guideline provides up-to-date guidance regarding broader indications for testing and treatment of Chlamydia trachomatis infections; clearer recommendation of using validated nucleic acid amplification tests only for diagnosis; advice on (repeated) Chlamydia trachomatis testing; recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection and recommendations to identify, verify and report Chlamydia trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of Chlamydia trachomatis patients are crucial to control its spread.
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Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, UK
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Lanjouw E, Ouburg S, de Vries HJ, Stary A, Radcliffe K, Unemo M. 2015 European guideline on the management of Chlamydia trachomatis infections. Int J STD AIDS 2015; 27:333-48. [PMID: 26608577 DOI: 10.1177/0956462415618837] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/01/2015] [Indexed: 12/19/2022]
Abstract
Chlamydia trachomatis infections, which most frequently are asymptomatic, are major public health concerns globally. The 2015 European C. trachomatis guideline provides: up-to-date guidance regarding broader indications for testing and treatment of C. trachomatis infections; a clearer recommendation of using exclusively-validated nucleic acid amplification tests for diagnosis; advice on (repeated) C. trachomatis testing; the recommendation of increased testing to reduce the incidence of pelvic inflammatory disease and prevent exposure to infection; and recommendations to identify, verify and report C. trachomatis variants. Improvement of access to testing, test performance, diagnostics, antimicrobial treatment and follow-up of C. trachomatis patients are crucial to control its spread. For detailed background, evidence base and discussions, see the background review for the present 2015 European guideline on the management of Chlamydia trachomatis infections (Lanjouw E, et al. Int J STD AIDS. 2015).
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Affiliation(s)
- E Lanjouw
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Ouburg
- Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - H J de Vries
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands STI Outpatient Clinic, Infectious Disease Cluster, Health Service Amsterdam, Amsterdam, The Netherlands Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - A Stary
- Outpatients' Centre for Infectious Venereodermatological Diseases, Vienna, Austria
| | - K Radcliffe
- University Hospital Birmingham Foundation NHS Trust, Birmingham, United Kingdom
| | - M Unemo
- WHO Collaborating Center for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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28
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Bánvölgyi A, Balla E, Bognár P, Tóth B, Ostorházi E, Bánhegyi D, Kárpáti S, Marschalkó M. [Lymphogranuloma venereum: the first Hungarian cases]. Orv Hetil 2015; 156:36-40. [PMID: 25544054 DOI: 10.1556/oh.2015.30083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Lymphogranuloma venereum is a sexually transmitted infection caused by the Chlamydia trachomatis serovars L1-3. It has been found to be endemic in tropical countries. In the last decades several cases have been reported in Western Europe, particularly in men who have sex with men population infected with human immunodeficiency virus. The authors present three cases of lymphogranuloma venereum infections, observed at their department in 2013 and 2014. The three human immunodeficiency virus infected patients who belonged to men who have sex with men population had casual sexual contacts in Western Europe. The symptoms included urethral discharge, discomfort and inguinal lymphadenomegaly in two patients, and rectal pain, discharge and perianal ulceration in one patient. The diagnosis was confirmed by nucleic acid amplification test performed in samples obtained from urethral discharge and exudate of perianal ulcer; lymphogranuloma venereum 2b serovars were demonstrated in two patients and serovar 2 in one patient. Doxycyclin (daily dose of two times 100 mg for 21 days) resolved the symptoms in all cases. The authors conclude that lymphogranuloma venereum is a diagnostic challenge in Hungary, too. It is important to be aware of the altered clinical features of this disease to prevent complications and spreading.
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Affiliation(s)
- András Bánvölgyi
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Eszter Balla
- Országos Epidemiológiai Központ II. Bakteriológiai Osztály, STI Laboratórium Budapest
| | - Péter Bognár
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Béla Tóth
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Eszter Ostorházi
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Dénes Bánhegyi
- Egyesített Szent László és Szent István Kórház V. Infektológiai Osztály Budapest
| | - Sarolta Kárpáti
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
| | - Márta Marschalkó
- Semmelweis Egyetem, Általános Orvostudományi Kar Bőr-, Nemikórtani és Bőronkológiai Klinika Budapest Mária u. 41. 1085
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Effects of Mentha suaveolens essential oil on Chlamydia trachomatis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:508071. [PMID: 25685793 PMCID: PMC4320923 DOI: 10.1155/2015/508071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/13/2014] [Indexed: 11/23/2022]
Abstract
Chlamydia trachomatis, the most common cause of sexually transmitted bacterial infection worldwide, has a unique biphasic developmental cycle alternating between the infectious elementary body and the replicative reticulate body. C. trachomatis is responsible for severe reproductive complications including pelvic inflammatory disease, ectopic pregnancy, and obstructive infertility. The aim of our study was to evaluate whether Mentha suaveolens essential oil (EOMS) can be considered as a promising candidate for preventing C. trachomatis infection. Specifically, we investigated the in vitro effects of EOMS towards C. trachomatis analysing the different phases of chlamydial developmental cycle. Our results demonstrated that EOMS was effective towards C. trachomatis, whereby it not only inactivated infectious elementary bodies but also inhibited chlamydial replication. Our study also revealed the effectiveness of EOMS, in combination with erythromycin, towards C. trachomatis with a substantial reduction in the minimum effect dose of antibiotic. In conclusion, EOMS treatment may represent a preventative strategy since it may reduce C. trachomatis transmission in the population and, thereby, reduce the number of new chlamydial infections and risk of developing of severe sequelae.
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Ali MA, Arnold CA, Singhi AD, Voltaggio L. Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics. Gastrointest Endosc 2014; 80:689-706. [PMID: 25070906 DOI: 10.1016/j.gie.2014.04.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 04/29/2014] [Indexed: 02/07/2023]
Affiliation(s)
- M Aamir Ali
- Department of Gastroenterology, George Washington University Hospital, Washington, District of Columbia, USA
| | | | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lysandra Voltaggio
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Kendall BA, Tardif KD, Schlaberg R. Chlamydia trachomatisL serovars and dominance of novel L2bompAvariants, USA. Sex Transm Infect 2014; 90:336. [DOI: 10.1136/sextrans-2013-051478] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Foschi C, Marangoni A, D'Antuono A, Nardini P, Compri M, Bellavista S, Filippini A, Bacchi Reggiani ML, Cevenini R. Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy. BMC Res Notes 2014; 7:225. [PMID: 24716676 PMCID: PMC3984434 DOI: 10.1186/1756-0500-7-225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy. Methods A total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing. Results L2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P = 0.0046). LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P = 0.0008) and presented more STIs (P = 0.0023) than LGV negative ones, in particular due to syphilis (P < 0.001), HIV (P < 0.001) and HBV (P = 0.001). Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P = 0.001 and P = 0.010). Conclusions Even if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilis-positive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification.
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Affiliation(s)
| | - Antonella Marangoni
- Microbiology, DIMES, University of Bologna, St, Orsola Hospital, Via Massarenti, 9, 40138 Bologna, Italy.
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de Vrieze NHN, de Vries HJC. Lymphogranuloma venereum among men who have sex with men. An epidemiological and clinical review. Expert Rev Anti Infect Ther 2014; 12:697-704. [PMID: 24655220 DOI: 10.1586/14787210.2014.901169] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lymphogranuloma venereum (LGV) is a sexually transmitted infection, previously only seen in tropical regions. This changed in 2003 when the first endemically acquired LGV cases were reported in Rotterdam, the Netherlands, among predominantly HIV positive men who have sex with men (MSM). Early diagnosis is important to prevent irreversible complications and to stop further transmission in the community. In contrast to earlier reports, approximately 25% of LGV infections are asymptomatic and form an easily missed undetected reservoir. The majority of reported infections in MSM are found in the anorectal canal and not urogenital, which leaves the mode of transmission within the MSM network unclear. Given the increasing trend, the LGV endemic is clearly not under control. Therefore directed screening must be intensified.
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Macdonald N, Sullivan AK, French P, White JA, Dean G, Smith A, Winter AJ, Alexander S, Ison C, Ward H. Risk factors for rectal lymphogranuloma venereum in gay men: results of a multicentre case-control study in the U.K. Sex Transm Infect 2014; 90:262-8. [PMID: 24493859 PMCID: PMC4033107 DOI: 10.1136/sextrans-2013-051404] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To identify risk factors for rectal lymphogranuloma venereum (rLGV) in men who have sex with men (MSM). Design A case-control study at 6 UK hospitals compared MSM with rLGV (cases) with rLGV-negative controls: MSM without potential rLGV symptoms (CGa) and separately, MSM with such symptoms (CGs). Methods Between 2008 and 2010, there were 90 rLGV cases, 74 CGa and 69 CGs recruited. Lifestyles and sexual behaviours in the previous 3 months were reported using internet-based computer-assisted self-interviews. Logistic regression was used to investigate factors associated with rLGV. Results Cases were significantly more likely to be HIV-positive (89%) compared with CGa (46%) and CGs (64%). Independent behavioural risks for rLGV were: unprotected receptive anal intercourse (adjusted OR (AOR)10.7, 95% CI 3.5 to 32.8), fisting another (AOR=6.7, CI 1.8 to 25.3), sex under the influence of gamma-hydroxybutyrate (AOR=3.1, CI 1.3 to 7.4) and anonymous sexual contacts (AOR=2.7, CI 1.2 to 6.3), compared with CGa; unprotected insertive anal intercourse (AOR=4.7, CI 2.0 to 10.9) and rectal douching (AOR=2.9 CI 1.3 to 6.6), compared with CGs. An incubation period from exposure to symptoms of 30 days was indicated. Conclusions Unprotected receptive anal intercourse is a key risk factor for rectal LGV with the likelihood that rectal-to-rectal transmission is facilitated where insertive anal sex also occurs. The association between HIV and rLGV appears linked to HIV-positive men seeking unprotected sex with others with the same HIV status, sexual and drug interests. Such men should be targeted for frequent STI screening and interventions to minimise associated risks.
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Affiliation(s)
- N Macdonald
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - A K Sullivan
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - P French
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - J A White
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Dean
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Smith
- Jefferiss Wing Centre for Sexual Health, Imperial College Healthcare NHS Trust, London, UK
| | - A J Winter
- Sandyford Sexual Health Services, Glasgow, UK
| | - S Alexander
- Sexually Transmitted Bacterial Reference Unit, Public Health England, London, UK
| | - C Ison
- Sexually Transmitted Bacterial Reference Unit, Public Health England, London, UK
| | - H Ward
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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Schiller LR, Pardi DS, Spiller R, Semrad CE, Surawicz CM, Giannella RA, Krejs GJ, Farthing MJG, Sellin JH. Gastro 2013 APDW/WCOG Shanghai working party report: chronic diarrhea: definition, classification, diagnosis. J Gastroenterol Hepatol 2014; 29:6-25. [PMID: 24117999 DOI: 10.1111/jgh.12392] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 02/06/2023]
Abstract
Diarrhea is best defined as passage of loose stools often with more frequent bowel movements. For clinical purposes, the Bristol Stool Form Scale works well to distinguish stool form and to identify loose stools. Laboratory testing of stool consistency has lagged behind. Acute diarrhea is likely to be due to infection and to be self-limited. As diarrhea becomes chronic, it is less likely to be due to infection; duration of 1 month seems to work well as a cut-off for chronic diarrhea, but detailed scientific knowledge is missing about the utility of this definition. In addition to duration of diarrhea, classifications by presenting scenario, by pathophysiology, and by stool characteristics (e.g. watery, fatty, or inflammatory) may help the canny clinician refine the differential diagnosis of chronic diarrhea. In this regard, a careful history remains the essential part of the evaluation of a patient with diarrhea. Imaging the intestine with endoscopy and radiographic techniques is useful, and biopsy of the small intestine and colon for histological assessment provides key diagnostic information. Endomicroscopy and molecular pathology are only now being explored for the diagnosis of chronic diarrhea. Interest in the microbiome of the gut is increasing; aside from a handful of well-described infections because of pathogens, little is known about alterations in the microbiome in chronic diarrhea. Serological tests have well-defined roles in the diagnosis of celiac disease but have less clearly defined application in autoimmune enteropathies and inflammatory bowel disease. Measurement of peptide hormones is of value in the diagnosis and management of endocrine tumors causing diarrhea, but these are so rare that these tests are of little value in screening because there will be many more false-positives than true-positive results. Chemical analysis of stools is of use in classifying chronic diarrhea and may limit the differential diagnosis that must be considered, but interpretation of the results is still evolving. Breath tests for assessment of carbohydrate malabsorption, small bowel bacterial overgrowth, and intestinal transit are fraught with technical limitations that decrease sensitivity and specificity. Likewise, tests of bile acid malabsorption have had limited utility beyond empirical trials of bile acid sequestrants.
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Haar K, Dudareva-Vizule S, Wisplinghoff H, Wisplinghoff F, Sailer A, Jansen K, Henrich B, Marcus U. Lymphogranuloma venereum in men screened for pharyngeal and rectal infection, Germany. Emerg Infect Dis 2013; 19:488-92. [PMID: 23621949 PMCID: PMC3647660 DOI: 10.3201/eid1903.121028] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To determine prevalence of lymphogranuloma venereum among men who have sex with men in Germany, we conducted a multicenter study during 2009–2010 and found high rates of rectal and pharyngeal infection in men positive for the causative agent, Chlamydia trachomatis. Many infections were asymptomatic. An adjusted C. trachomatis screening policy is justified in Germany.
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Koper NE, van der Sande MA, Gotz HM, Koedijk FD, on behalf of the Dutch STI clinics C. Lymphogranuloma venereum among men who have sex with men in the Netherlands: regional differences in testing rates lead to underestimation of the incidence, 2006-2012. Euro Surveill 2013; 18. [DOI: 10.2807/1560-7917.es2013.18.34.20561] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- N E Koper
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - M A van der Sande
- Academic Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - H M Gotz
- Department of Infectious Disease Control, Rotterdam Rijnmond Public Health Service, Rotterdam, the Netherlands
| | - F D Koedijk
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National institute for Public Health and the Environment, Bilthoven, the Netherlands
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Abstract
Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases, remain a growing worldwide problem and public health issue. This article covers the epidemiology of STIs, the history and physical findings, screening guidelines, and the general plan to combat STIs. Prevention is discussed using the latest information from the Centers for Disease Control and Prevention and other references. Infections discussed from the standpoint of cause, epidemiology, risk factors, clinical disease, diagnosis, and treatment include gonorrhea, Chlamydia trachomatis, Trichomonas vaginalis, syphilis, chancroid, Herpes simplex, lymphogranuloma venereum, granuloma inguinale, Herpes papilloma virus, Molluscum contagiosum, and pubic lice.
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Affiliation(s)
- William Markle
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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39
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Brook G, McSorley J, Shaw A. Retrospective study of the effect of enhanced systematic sexually transmitted infection screening, facilitated by the use of electronic patient records, in an HIV-infected cohort. HIV Med 2013; 14:347-53. [PMID: 23432731 DOI: 10.1111/hiv.12020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 12/01/2022]
Affiliation(s)
- G Brook
- Department of Sexual Health and HIV; North West London Hospitals NHS Trust; London; UK
| | - J McSorley
- Department of Sexual Health and HIV; North West London Hospitals NHS Trust; London; UK
| | - A Shaw
- Department of Sexual Health and HIV; North West London Hospitals NHS Trust; London; UK
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40
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Distinct transmission networks of Chlamydia trachomatis in men who have sex with men and heterosexual adults in Amsterdam, The Netherlands. PLoS One 2013; 8:e53869. [PMID: 23342025 PMCID: PMC3547048 DOI: 10.1371/journal.pone.0053869] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 12/06/2012] [Indexed: 11/23/2022] Open
Abstract
Background Genovar distributions of Chlamydia trachomatis based on ompA typing differ between men who have sex with men (MSM) and heterosexuals. We investigated clonal relationships using a high resolution typing method to characterize C. trachomatis types in these two risk groups. Methods C. trachomatis positive samples were collected at the STI outpatient clinic in Amsterdam between 2008 and 2010 and genotyped by multilocus sequence typing. Clusters were assigned using minimum spanning trees and these were combined with epidemiological data of the hosts. Results We typed 526 C. trachomatis positive samples: 270 from MSM and 256 from heterosexuals. Eight clusters, containing 10–128 samples were identified of which 4 consisted of samples from MSM (90%–100%), with genovars D, G, J, and L2b. The other 4 clusters consisted mainly of samples from heterosexuals (87%–100%) with genovars D, E, F, I, and J. Genetic diversity was much lower in the MSM clusters than in heterosexual clusters. Significant differences in number of sexual partners and HIV-serostatus were observed for MSM–associated clusters. Conclusions C. trachomatis transmission patterns among MSM and heterosexuals were largely distinct. We hypothesize that these differences are due to sexual host behavior, but bacterial factors may play a role as well.
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Busson L, Crucitti T, De Foor M, Van den Wijngaert S, Vandenberg O. Observation of a cytopathogenic effect on cell lines used for routine viral cultures led to the diagnosis of lymphogranuloma venereum. Sex Transm Infect 2012; 89:395-7. [PMID: 23220783 DOI: 10.1136/sextrans-2012-050785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This article reports the fortuitous recovery of nine Chlamydia trachomatis serovar L strains in cell cultures (Vero and LLC-MK(2) cell line) designed for viral culture. METHODS Nine ano-genital swabs were inoculated on confluent Vero, MRC5 and LLC-MK(2) cell cultures. They were collected from HIV-positive patients who were primarily men who have sex with men (MSM) presenting ulcerations that mimicked herpes simplex infections. RESULTS A cytopathogenic effect was observed on Vero and LLC-MK(2) cells on day 14. The presence of C trachomatis serovar L in the cell lines was confirmed by Real Time-PCR. CONCLUSIONS C trachomatis serovar L can grow on Vero and LLC-MK(2) cell lines designed for viral cultures. Lymphogranuloma venereum must be considered as a differential diagnosis for herpes-like lesions, particularly in MSM with high-risk behaviours.
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Affiliation(s)
- Laurent Busson
- Department of Microbiology, Porte de Hal Laboratory, Saint-Pierre University Hospital & Jules Bordet Institute, Brussels, Belgium.
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Gallegos M, Bradly D, Jakate S, Keshavarzian A. Lymphogranuloma venereum proctosigmoiditis is a mimicker of inflammatory bowel disease. World J Gastroenterol 2012; 18:3317-21. [PMID: 22783058 PMCID: PMC3391771 DOI: 10.3748/wjg.v18.i25.3317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/17/2011] [Accepted: 05/12/2012] [Indexed: 02/06/2023] Open
Abstract
There has been an increasing prevalence of lymphogranuloma venereum (LGV) or Chlamydia trachomatis (C. trachomatis) cases among the men who have sex with men (MSM) population, particularly in Europe and North America. These cases may present with an incomplete or undisclosed history and proctosigmoiditis without characteristic adenopathy syndrome. During the initial evaluation and colonoscopy, there is a strong clinical and endoscopic suspicion of inflammatory bowel disease (IBD) by virtue of presentation and endoscopic and histological findings. The diagnosis of IBD is subsequently modified to LGV proctosigmoiditis when one or more of the following transpire: (1) there is failure of response to IBD therapy; (2) additional components of history (MSM/travel) may be identified; (3) return of initially performed Chlamydia antibody test is positive; and (4) response to antibiotics effective against Chlamydia. We describe three such cases initially suspected to be an inflammatory bowel disease and subsequently identified as C. trachomatis proctosigmoiditis.
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Castro JG, Ponomareva O, Alcaide M, Rosa-Cunha I, Dilanchian P, Willis D. Increase in Lymphogranuloma Venereum Cases in South Florida. ACTA ACUST UNITED AC 2012; 11:220-2. [DOI: 10.1177/1545109712447198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of the study was to evaluate the clinic prevalence and clinical characteristics of patients with LGV since 2007 when active clinic surveillance started. We review all the reports of rectal Chlamydia trachomatis and LGV testing of those samples. Chlamydia trachomatis LGV DNA was detected by Nucleic Acid Amplification/ompA gene sequencing. Medical records of all patients with LGV were reviewed. Prevalence of rectal CT among tested individuals was relatively stable during the study period: 2007 (15%), 2008 (15%), 2009 (12%) and 2010 (14%). Eight cases of LGV were identified during the study period, one in 2009 and seven in 2010. All individuals were male and all except one had sex with only men. Most of them were also infected with HIV (62.5%). We concluded that this is the first report of LGV cases in South Florida and shows a rapid increase in the number of cases in the last year.
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Affiliation(s)
- José Guillermo Castro
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Olga Ponomareva
- Bureau of Laboratories, Florida Department of Health, Miami, FL, USA
| | - María Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isabella Rosa-Cunha
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Paula Dilanchian
- Fellow Infectious Diseases, Jackson Memorial Hospital, Miami, FL, USA
| | - Dean Willis
- Bureau of Laboratories, Florida Department of Health, Miami, FL, USA
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44
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Lemonovich TL, Salata RA. Chancroid and Lymphogranuloma Venereum. Sex Transm Dis 2012. [DOI: 10.1002/9781118314937.ch6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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45
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Abstract
A new study reports comparative genomic analysis of 52 geographically diverse strains of Chlamydia trachomatis. The authors reconstruct a genome-wide phylogeny of the species and report extensive genome-wide recombination across multiple lineages of this intracellular bacterial pathogen.
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46
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Hoentjen F, Rubin DT. Infectious proctitis: when to suspect it is not inflammatory bowel disease. Dig Dis Sci 2012; 57:269-73. [PMID: 21994137 DOI: 10.1007/s10620-011-1935-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/26/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND Proctitis is a common problem and is most frequently associated with inflammatory bowel diseases. However, the incidence of infectious proctitis appears to be rising, especially in men who have sex with men. This may be due to the rise of people participating in receptive anal sex as well as the increase in sexually transmitted infections. The most frequently reported pathogens include Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum, and herpes simplex. DIAGNOSIS Symptoms of infectious proctitis can include rectal blood and mucous discharge, anorectal pain, ulcers, and occasionally lymphadenopathy and fever. History and physical examination are crucial in establishing a diagnosis, supported by endoscopy, histology, serology, culture and PCR. TREATMENT Treatment with antibiotics or antivirals is usually initiated, either empirically or after establishing a diagnosis. Co-infections, HIV testing, and treatment of sexual partners should always be considered.
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Affiliation(s)
- Frank Hoentjen
- Inflammatory Bowel Disease Center, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC4076, Chicago, IL 60637, USA.
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47
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Zhang L, Qian HZ, Blevins ML, Yin L, Ruan Y, Vermund SH. Internet-based behavioral interventions for preventing HIV infection in men who have sex with men (MSM). Hippokratia 2011. [DOI: 10.1002/14651858.cd009525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lan Zhang
- Vanderbilt University; Institute for Global Health; Nashville Tennessee USA 37203
| | - Han-zhu Qian
- Vanderbilt University; Institute for Global Health; Nashville Tennessee USA 37203
| | - Meridith L Blevins
- Vanderbilt University; Department of Biostatistics; Nashville Tennessee USA 37232
| | - Lu Yin
- Vanderbilt University; Institute for Global Health; Nashville Tennessee USA 37203
| | - Yuhua Ruan
- National Centre for AIDS/STD Control and Prevention (NCAIDS), China CDC; Beijing China 100050
| | - Sten H Vermund
- Vanderbilt University; Institute for Global Health; Nashville Tennessee USA 37203
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48
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Hypervirulent Chlamydia trachomatis clinical strain is a recombinant between lymphogranuloma venereum (L(2)) and D lineages. mBio 2011; 2:e00045-11. [PMID: 21540364 PMCID: PMC3088116 DOI: 10.1128/mbio.00045-11] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Chlamydia trachomatis is an obligate intracellular bacterium that causes a diversity of severe and debilitating diseases worldwide. Sporadic and ongoing outbreaks of lymphogranuloma venereum (LGV) strains among men who have sex with men (MSM) support the need for research on virulence factors associated with these organisms. Previous analyses have been limited to single genes or genomes of laboratory-adapted reference strain L2/434 and outbreak strain L2b/UCH-1/proctitis. We characterized an unusual LGV strain, termed L2c, isolated from an MSM with severe hemorrhagic proctitis. L2c developed nonfusing, grape-like inclusions and a cytotoxic phenotype in culture, unlike the LGV strains described to date. Deep genome sequencing revealed that L2c was a recombinant of L2 and D strains with conserved clustered regions of genetic exchange, including a 78-kb region and a partial, yet functional, toxin gene that was lost with prolonged culture. Indels (insertions/deletions) were discovered in an ftsK gene promoter and in the tarp and hctB genes, which encode key proteins involved in replication, inclusion formation, and histone H1-like protein activity, respectively. Analyses suggest that these indels affect gene and/or protein function, supporting the in vitro and disease phenotypes. While recombination has been known to occur for C. trachomatis based on gene sequence analyses, we provide the first whole-genome evidence for recombination between a virulent, invasive LGV strain and a noninvasive common urogenital strain. Given the lack of a genetic system for producing stable C. trachomatis mutants, identifying naturally occurring recombinants can clarify gene function and provide opportunities for discovering avenues for genomic manipulation. Lymphogranuloma venereum (LGV) is a prevalent and debilitating sexually transmitted disease in developing countries, although there are significant ongoing outbreaks in Australia, Europe, and the United States among men who have sex with men (MSM). Relatively little is known about LGV virulence factors, and only two LGV genomes have been sequenced to date. We isolated an LGV strain from an MSM with severe hemorrhagic proctitis that was morphologically unique in tissue culture compared with other LGV strains. Bioinformatic and statistical analyses identified the strain as a recombinant of L2 and D strains with highly conserved clustered regions of genetic exchange. The unique culture morphology and, more importantly, disease phenotype could be traced to the genes involved in recombination. The findings have implications for bacterial species evolution and, in the case of ongoing LGV outbreaks, suggest that recombination is a mechanism for strain emergence that results in significant disease pathology.
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Høie S, Knudsen LS, Gerstoft J. Lymphogranuloma venereum proctitis: a differential diagnose to inflammatory bowel disease. Scand J Gastroenterol 2011; 46:503-10. [PMID: 21114426 DOI: 10.3109/00365521.2010.537681] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Lymphogranuloma venereum (LGV) is a sexually transmitted disease, endemic in tropical and subtropical areas for many years. After 2003 there have been several outbreaks in western countries, especially among HIV-positive men who have sex with men (MSM). An important manifestation of LGV is a proctitis, with a clinical presentation and endoscopic findings resembling those of inflammatory bowel diseases (IBDs). LGV is considered new in Scandinavia. This case report focuses on difficulties in differentiating LGV and IBD. MATERIAL AND METHODS This case report used a systematic search in the literature using PubMed and clinical cases from the Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark (Cases 1-3) and the Section of Surgery, Hamar Hospital, Norway (Case 4). RESULTS Clinical and endoscopic findings in LGV and IBD resemble each other. All cases were MSM. Three out of four were HIV-positive. Three out of four contacted their general practitioner (GP) due to gastrointestinal (GI) symptoms, and were referred to a gastroenterologist (GE) with suspicion of IBD. Because of non-successful IBD treatment, control of HIV status, relapses of GI-symptoms or extended information concerning sexual habits, LGV was suspected and diagnosed. All patients responded with remission of GI-symptoms and endoscopic findings after oral treatment with doxycycline. CONCLUSION Due to similarities between LGV and IBD, LGV should be considered as a differential diagnosis in patients with proctitis or IBD-related symptoms, especially among HIV-positive men. Hence LGV patients may be spared long-lasting examination, mistreatment and surgery.
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Affiliation(s)
- Sverre Høie
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Denmark.
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Rönn MM, Ward H. The association between lymphogranuloma venereum and HIV among men who have sex with men: systematic review and meta-analysis. BMC Infect Dis 2011; 11:70. [PMID: 21418569 PMCID: PMC3070636 DOI: 10.1186/1471-2334-11-70] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 03/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphogranuloma venereum (LGV) is an important re-emerging sexually transmitted infection which is reported to affect particularly HIV-positive men who have sex with men (MSM). The aim of this study is to quantify the association between LGV and HIV in the context of the current emergence of LGV. METHODS A systematic review was performed on the emergence of LGV among MSM since 2000. We report the prevalence of HIV infection from descriptive studies of MSM with LGV, and conduct a meta-analysis to produce a summary estimate of the association between LGV and HIV from case-control studies where cases were MSM with LGV and controls were MSM with rectal chlamydia caused by non-LGV serovars. RESULTS The prevalence of HIV among LGV cases ranges from 67% to 100% in 13 descriptive studies. There is a significant association between HIV and LGV (odds ratio 8.19, 95% CI 4.68-14.33). CONCLUSIONS HIV-positive MSM are disproportionately affected by LGV highlighting the importance of prevention efforts to be targeted to this group. Further research is needed to determine whether the association is due to biological or behavioural factors.
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Affiliation(s)
- Minttu M Rönn
- Department of Infectious Disease Epidemiology, Imperial College London, Old Medical School, St. Mary's Campus, Norfolk Place, Paddington, W2 1PG London, UK
| | - Helen Ward
- Department of Infectious Disease Epidemiology, Imperial College London, Old Medical School, St. Mary's Campus, Norfolk Place, Paddington, W2 1PG London, UK
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